Infant Deaths From Medical Causes After a Maltreatment Report

Abstract

OBJECTIVES: To examine whether postneonatal infants reported for maltreatment face a heightened risk of deaths attributable to medical causes.METHODS: Birth and death records for all children born in California between 2010 and 2016 (N 5 3 455 985) were linked to administrative child protection system records. Infants were prospectively followed from birth through death or age 1 year. Reports of maltreatment and foster care placement episodes were modeled as time-varying covariates; sociodemographic characteristics at birth were modeled as baseline covariates. Stratified, multivariable competing risk models were used to estimate the adjusted relative hazard of postneonatal infant death attributed to a medical cause (n 5 1051).RESULTS: After adjusting for baseline risk factors, and compared with infants never reported for maltreatment, the medical-related mortality risk was almost twice as great among infants reported once for maltreatment (hazard ratio: 1.77; 95% confidence interval: 1.36-2.30) and 3 times greater if there was >1 maltreatment report (hazard ratio: 3.27; 95% confidence interval: 2.48, 4.30). Among infants reported for maltreatment, periods of foster care placement reduced the risk of death by roughly half.CONCLUSION: Infants reported for alleged maltreatment had a higher risk of death from medical causes, with foster care emerging as protective. Targeted support services for parents and improved communication between the child protection system and the pediatric health care community is needed, especially when infants who may be medically fragile and remain at home after an allegation of abuse or neglect.

Infants reported for maltreatment had an increased risk of death from medical causes

“…This study provides evidence that infants reported for child maltreatment are at an increased risk of death from medical causes 2. Similar work has not been undertaken in the UK, where health and social care structures differ from those in the USA.…”

“…The authors of the study conclude that ‘differences in death rates signal potential unmet service needs among infants who remain at home after reports’ 2. The general paediatrician can play an important role in meeting this need and there should be a low threshold for medical follow-up after a child protection medical assessment, particularly in children who have had more than one episode of reported maltreatment.…”

A Population-Level Examination of Incarcerated Women and Mothers Before and After the California Public Safety Realignment Act

“…Fifth, the data suggest that mothers incarcerated in state prison have different birth characteristics than nonincarcerated mothers in California. In comparison to demographics documented using California’s birth records (Putnam-Hornstein & Needell, 2011 ; Schneiderman et al, 2021 ), incarcerated mothers were more likely to be Black (15% vs. 5%), less likely to have a high school degree (50% vs. 73%), less likely to have paternity established on the birth record (65% vs. 93%), and more likely to have public health insurance (an indicator of lower income; 72% vs. 49%%) when compared to all mothers. These findings align with research showing Black women are overrepresented among women in prison (Gifford et al, 2021 ) and suggests next-generation consequences of pervasive racial differences in criminal justice involvement and incarceration (Wakefield & Wildeman, 2011 ).…”

A longitudinal investigation of infants and out-of-home care

“…According to federal sources, almost one-half (45.4%) of child fatalities in 2019 involved children under the age of one (U.S. Department of Health & Human Services, 2021). In one state specific study, infants reported for maltreatment were almost two times more likely to die of medical causes in the first year of life, compared to all other infants, controlling for baseline risks (Schneiderman, Prindle, & Putnam-Hornstein, 2021).…”